CYFRA-21-1 IN THE FOLLOW-UP OF PATIENTS WITH LOCALLY ADVANCED NON-SMALL-CELL LUNG-CANCER DURING AND AFTER NEOADJUVANT CHEMORADIOTHERAPY ANDSURGERY

Background: For the neoadjuvant chemo-radiotherapy and surgery of pati ents with locally far advanced non-small cell lung cancer (NSCLC) sens itive and specific tumor markers are mandatory as pretherapeutically d eterminable prognostic factors for treatment decision and as parameter s of follow-up for treatment control. Therefore, CYFRA 21-1, the tumor marker with the highest sensitivity in NSCLC, was investigated before and during follow-up and correlated with the clinical outcome. Patien ts and methods: In 50 patients with stage IIIA and IIIB NSCLC the time course of CYFRA 21-1 and other tumor markers was determined by radio- or enzyme-immunoassay in correlation with the clinical follow-up. Res ults: The sensitivity of CYFRA 21-1 was 56% (28/50 patients). The clin ical response to the neoadjuvant chemo-radiotherapy could be accuratel y estimated by CYFRA 21-1 in 17 of the 21 evaluable patients (81%), wh o were initially tumor marker-positive. Relapses, metastatic spread or progression of disease could be correctly diagnosed by the time cours e of CYFRA 21-1 in 12 of 17 evaluable patients. Accordingly, the sensi tivity of the kinetics of CYFRA 21-1 is in the range of 70% at a high specificity, as in none of the 11 patients without evidence of disease (NED) a pathological increase of CYFRA 21-1 was observed. Conclusion: The results indicate that CYFRA 21-1 is of high significance not only for treatment control but also as a prognostic parameter for treatmen t decision regarding thoracotomy in the course of neoadjuvant chemo-ra diotherapy with surgery of patients with locally far advanced NSCLC, w hich must be confirmed by multivariate analysis as soon as the number of patients evaluable for the endpoints survival or relapse-free survi val is high enough for a statistically relevant evaluation.